Intestinal stenosis of Garré: A rare cause of small bowel obstruction in the virgin abdomen

Abstract

HighlightsReports of strictures following strangulated hernia repair are few, presented in different languages, and the data is frequently incomplete. We present a case report and a comprehensive literature review over the last century.Intestinal stenosis of Garré was more frequently reported to follow inguinal hernia repair than femoral hernia repair (57.1% vs. 42.9%).Most males developed a delayed stricture following an inguinal hernia repair (93.3%). 84.6% of females, on the other hand, developed intestinal stenosis following repair of a femoral hernia87.5% of strictures developed on the right side. The terminal ileum is the narrowest part of the small bowel and is the segment where a stricture would result in the biggest impact.The timing of development of a bowel obstruction is very variable and ranges from 5 days to 22 years. 22 patients (68.8%), however, presented with an obstruction within 5 months of hernia repair.

Combined laparoscopic resection of intestinal stenosis of Garré and open preperitoneal mesh repair for irreducible femoral hernia

“…All previously reported cases described intestinal stenosis of Garré as occurring after groin hernia repair that was surgically performed in two stages, with repair of the groin hernia and resection of the small intestine . In the present case, we performed small intestinal resection and hernia repair in one operation after the manual reduction of an incarcerated femoral hernia.…”

“…We searched for articles published between 1900 and 2016 in PubMed and MEDLINE using the terms “intestinal stenosis,” “intestinal stricture,” and “intestinal stenosis or stricture following hernia repair.” We found that 33 cases have been reported to date , and among them, 88% of strictures developed on the right side. Furthermore, all of the strictures that had been caused by a femoral hernia (13 cases) developed on the right side.…”

“…Previous authors have described these strictures as commonly occurring within 30 cm of the ileocecal valve, because the terminal ileum is the narrowest part of the small bowel. Therefore, a right groin hernia is likely to contain a loop of distal ileum .…”

“…Based on this point of view, we reviewed the time from hernia repair to onset of intestinal stenosis of Garré, which varied greatly from 5 days to 22 years . However, 12 patients (36.4%) presented with intestinal obstruction within 1 month after hernia repair.…”

Laparoscopic Management of Strangulated Broad Ligament Hernia

“…7 The causes for small bowel obstruction in a virgin abdomen are internal hernias, congenital bands, bowel tumors, Meckel's diverticulum, and luminal obstruction by bezoars or foreign bodies. [8][9][10] Most of these are managed by surgery after variable periods of conservative treatment. The most common mode of presentation for BLH consists of abdominal pain, particularly "colicky abdominal pain", 11 and nausea and/or vomiting.…”